Thread by @khurramn1

#COVID19 recovery?

My thoughts below

For most of us on the frontline including myself, the 100% focus in the last 4 months, rightly so, been on beating the initial sickness

Unaware it may be just the first of many battles

Sometimes we all need perspective (definitely I did)

#2
For me, As a physician, it was my collogues, including Dr Wu a surgeon one of the first doctors falling sick all across in US

learning from their personal experience as a patient….

getting insights on their anxieties, isolation and struggles was an eye opening experience

#3
Social media is full of stories with such struggles

As a population health scentist I always viewed these scattered reports with skepticism…

trained not to place to much emphasis on ancedotes…

But I was wrong…

in fact these are not isolated experiences

Now there are robust data that have systematically confirmed that majority of those hospitalized don’t completely recover

Even after 2 months of discharge only 12% feel completely normal

#5
There are also lessons of of caution for those suggesting a path of herd immunity…

by getting over with the infection….because you are not in the high risk

Even if COVID doesn’t result in hospitalization, there is no such thing as getting over

The question is Why such a prolonged recovery…

while primarily a lung disease, consider it like a cluster bomb exploding in your body having a ripple effect throughout the body….affecting every organ

Series of autopsies studies
Unifying themes is that a more prominent feature & likely underlying culprit is platelet activation & uncontrolled cascade of the coagulation pathway
platelet-rich thrombi in virtually every circulatory beds
little sign of inflammatory infiltrates

#8

While most of the data to date has focused on the acute phase insults on the organ, slowly information is percolating about long term damage
3 in 4 with abnormal lung function
1 in 2 abnormal CT findings
1 in 4 with severe disease had lung fibrosis

Now we evidence that the heart is not only affected in acute settings, but Signs of Cardiac Damage can linger on for months

2-3 months in recovery
Majority with elevated troponin
Up to two thirds with reduced cardiac function
Right>Left sided involvement

#9

Surprisingly, and unusually, the brain is also not sparred in COVID
1 in 2 with neurological symptoms
1 in 5 with disorders of consciousness
7 fold increase risk of stroke vs influenza
Disruption micro-structural brain integrity in recovery

#10
Not to forget kidneys which are flying under the radar

A report from 2 days ago, In Mount Sinai 46% of patients had some form of acute kidney injury;

of those, 17% required urgent dialysis

"long-term burden for patients, the medical community - and the U.S. economy.”

#11
Should these findings surprise us?
Not really
our prior limited experiences with similar infections SARS, MERS, H1N1
though affecting a much small proportion
should have forewarned us of these persistent long term changes
only difference millions of individuals at risk now

In the context of this pandemic, one thing that has brought out in the open, that despite being the elephant in the room for decades

We can no longer ignore the racial disparities and social inequities anymore

@eff_ve showed irrespective of age, AA and Hispanics more likely to be affected by COVID 19

@NMHheartdoc on challenges where "preventive measures such as ability to isolate in safe home, work remotely with full digital access, sustain monthly income are components of privilege"

Clearly more work needs to be done
At the moment we have a superficial but absolutely on in-depth idea of what’s the recovery will look like
We need to plan for these immense challenges

Moving forward...
We all need to come together
Develop an integrated Post COVID Care clinical and research program
not only to help thousands of community members make a meaningful recovery
generate new knowledge that can favorably impact millions of those affected worldwide.

Inspite of all the challenges I am optimistic

OUR LEGACY at @HMethodistMD built on supporting community in the biggest crisis pre covid

came out with flying colors then

have no doubt, together, will triumph again

leaving another legacy for future generations to cherish

@eff_ve
showed irrespective of age, AA and Hispanics more likely to be affected by COVID 19
@NMHheartdoc on challenges where "preventive measures such as ability to isolate in safe home, work remotely with full digital access, sustain monthly income are components of privilege"

Moving forward...
We all need to come together
Develop an integrated Post COVID Care clinical and research program
not only to help thousands of community members make a meaningful recovery
generate new knowledge that can favorably impact millions of those affected worldwide.

Clearly more work needs to be done
Moving forward
Develop an integrated Post COVID Care clinical and research program
not only to help thousands of community members make a meaningful recovery
generate new knowledge that can favorably impact millions of those affected worldwide

@threadreaderapp unroll